At the end of 90 days, if money was saved, it would be split between
the orthopedic group and the company, with us — the surgeons —
receiving 65% and the convener group receiving 35%.
That threw me. Why, I wondered, was I giving away 35% of that prof-
it to a company that was doing the work I could be doing? That's
when a light bulb went off. I knew how to do cost-effective total joint
surgery and so did a handful of surgeons at the Surgical Center of
Greensboro, which we were building at the time.
Back then, it was just a surgery center. But what if we implemented
total joints? What if, for those total joints, we created our own bun-
dled payment system that we could offer to private payers like Blue
Cross Blue Shield or Aetna?
That led us to form Delta Joint Management — a relatively easy task
itself — that involved only registering for an LLC. The group lets us
control the bundle and negotiate all of the payments from it, including
the surgery center fee, the implant cost, the surgeon fee, the anesthe-
sia fee, home health and physical therapy.
In order to work with our surgery center, we had to find alignment
with them and make sure they were on board with the bundled pay-
ment idea. This, too, was easy because we're shareholders in the cen-
ter, which is owned by more than 50 surgeons and Surgical Care
Affiliates. We were lucky enough to find that our surgery center, espe-
cially Jenny Graham, RN, the director of the center, worked hard to
accommodate and plan our program with us. That alignment would be
the biggest key to our success.
Building bundled payments
Alignment was a twofold process for our company. Apart from getting
the center on board, we knew we had to get private payers to accept
our suggested bundled payments, too. The way we could do that was
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